Palliative care is frequently part of nursing practice in acute care settings. Research has evaluated nurses' general perceptions on end-of-life care in hospital and identified symptom management as a concern. The aim of this study was to explore nurses' perceptions regarding end-of-life medication use in an acute care setting to enable identification of variables that may impact symptom management and medication use at the end of life. Using a qualitative description methodology, 22 nurses from 8 medical and surgical units participated in 7 focus groups. Nurses were less likely to use medication when having difficulty identifying symptoms and when medications were not familiar. Other factors included conflicting perspectives and the emotional experience. Nurses felt that physicians were often reluctant to involve the palliative care team and experienced delays in obtaining orders or clarifying goals of care. Nurses felt uncomfortable with medication use when their feelings conflicted with family perspectives and found communication with families challenging overall. Nurses expressed a desire to achieve comfort but felt fears surrounding medication use. Fears included hastening death, adverse effects such as depressed respirations, and the possibility of pain pump errors or inappropriate use. Education and resources regarding symptom assessment and common end-of-life medications were identified as important.
KEY WORDSacute care, medication administration, nursing, palliative care I t is well recognized that adequate symptom management is a critical component of end-of-life care. Despite this knowledge, it is still common to have unmet symptom needs at the end of life. 1 This problem is most severe in areas that do not specialize in palliative care, particularly in the acute care setting. 2,3 In the hospital setting, health care professionals often do not recognize that a patient is approaching end of life, as the focus has been on active interventions. This may result in missed opportunities to optimize symptom control. As acute care settings tend to focus on cure and active management, transitioning to a palliative care model can be unclear or seen as a failure. 4,5 In general, there is a lack of current research available that focuses on end of life in the acute care setting.The literature does show that families are often dissatisfied with hospital care at the end of life and feel that there is a need for improved symptom control and communication with health care professionals. 6 Both staff and families report that the hospital environment may not be appropriate for end-of-life care because of high levels of noise, busyness, and lack of privacy as well as resource restrictions (eg, staffing levels and time). 6,7 When attempting to address the hospital nurses' perspectives, there is also limited research. The literature has focused on the challenges nurses face with providing endof-life care. Hospital nurses report feeling unprepared and often experience difficulties in meeting the needs of patients and fami...